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Study Aim: Endovascular surgery can be proposed as an alternative to infrainguinal conventional surgery in critical ischemia. The aim of this study was to report the latest results of our series of 186 patients., Materials and Methods: One hundred and eighty-six patients (100 women and 86 men; mean age 74.5 +/- 13 years) were treated for pain during rest (31.5%), gangrene (58%), or ischemic ulcer (10.5%). The lesions were unilateral (n = 172) or bilateral (n = 14). Two hundred eighty-seven target lesions were treated: for stenosis (n = 168) or occlusion (n = 119): of superficial femoral artery (31.7%), popliteal artery (40%) or tibial arteries (28.3%)., Results: Technical success was achieved in 81% (15% amputations). The in-hospital mortality rate was 6.5%. The cumulative patency rate was 61 +/- 3% at 12 months, and 52 +/- 6% at 48 months. The limb salvage rate was 87 +/- 3% at 12 months and 82 +/- 4% at 48 months. Thirteen potential factors of patency were analyzed: the only predictive factors affecting patency were occlusion versus stenosis, and the use of atherectomy (Log rank test: P < 0.001 and P < 0.0001)., Conclusion: Despite a risk of technical failure and of mid-term restenosis, endovascular surgery for critical ischemia provides a fair long-term limb salvage rate.

Diabetic arteriopathy is a specific entity as it associates macro-angiopathy ischemia factor and micro-angiopathy leading to peripheral neuropathy. This association leads to specific clinical manifestations dues to interplay of ischemic and infectious phenomena. Diffuse occlusive lesions predominate distally with mediacalcosis. Wider surgical indications for revascularization of distal vessels of the leg, the ankle and the foot have reduced the number and extent of amputation. Long-term permeability after salvage surgery is identical to that in non-diabetic patients as shown by our series of 695 distal revascularizations. Endovascular techniques with or without stents or recanalization are alternatives which may be indicated in case of short occlusions or trophic disorders contraindicating surgery. Associating stents with conventional surgery may also be indicated in diabetic patients. One final progress in reducing the number of amputations has been provided by free-transfer micro-surgery techniques which allow both vascular supply and coverage of distal tissue loss.